Antimicrobials
Amphotericin - Lipid Associated

Amphotericin - Lipid Associated

Restricted

Low
N/A

Spectrum of Activity

General Information

Administration

  • Administer IV over 2 hours, may be reduced to 1 hour if treatment is well-tolerated
  • Existing IV line should be flushed with D5W before and after infusion
  • In-line membrane filter not less than 1 micron may be used
  • Pre-medication recommended for patients with nonanaphylactic infusion-related reactions (See additional information)

Preparation

  • Reconstitute with 12mL of SWFI to a concentration of 4mg/mL and shake vigorously for at least 30 seconds
  • Should appear as a translucent yellow suspension
  • Further dilute using a 5-micron syringe filter into D5W
  • Final concentration of 1-2 mg/mL (lower concentration 0.2-0.5 mg/mL for infants and small children)

Compatibility

  • D5W

Fungicidal therapy of yeast/fungus/mold infection.

Invasive candidiasis, aspergillosis, cryptococcosis.

Visceral/mucocutaneous Leishmaniasis.

Induction therapy for dimorphic fungii (cocci, blasto, histo).

Not for use in urinary tract infection.

  • Renal function
  • K+
  • Mg++
  • HCO3-
  • Liver enzymes
  • CBC

Frequency depends on course, but daily reasonable during initiation

Same toxicities as conventional Amphotericin B but with less frequency.

  • Nephrotoxicity
  • Anemia
  • Phlebitis
  • Arachnoiditis
  • Urinary retention
  • Paresthesias

Infusion related symptoms

  • Fever
  • Rigors
  • N/V
  • Headache

Electrolyte abnormalities

  • HypoK and HypoMg
  • Loss of bicarb
  • See additional information

Main concern is concomitant nephrotoxins. Use should be minimized during amphotericin therapy.

Increased digoxin toxicity with hypokalemia.

Antimicrobial class: Antifungal. Polyene. Lipid formulations designed to minimize toxicity.

Average serum half life: 150 hours

Urine penetration: Poor

Lung penetration: Therapeutic

Biliary penetration: Therapeutic

AmBisome

Lipid associated AmB is taken up preferentially by phagocytic cells and concentrated at sites of infection while minimizing renal exposure.

Premedication with NSAIDs/acetaminophen, diphenhydramine, or hydrocortisone are used. Meperidine may be used for rigors.

Pay careful attention to electrolyte and fluid status with boluses (usually 500mL) before and after infusion, as well as K and Mg supplementation PRN.